Obamacare was a boon for many restaurant workers. Now what, they wonder?

Tom Holland inside his Juice Joint Cafe, which he had to shutter in October. (Astrid Riecken/for The Washington Post)

At the start of the new year, Tom Holland changed his health insurance. He signed up for a plan through the Affordable Care Act, otherwise known as Obamacare. He had little choice: His previous insurance didn’t cover many of the services he needed, including a biopsy scheduled for Jan. 9.

The former owner of the Juice Joint Cafe in downtown Washington had already canceled the biopsy once after learning “it would cost a grand to get that done,” he says. He knew he shouldn’t let the procedure slide any longer. The lump in his neck had not gotten any smaller since he first discovered it last spring.

“I did less [for my health] because I was underinsured. . . . It’s the perfect Catch-22: You’re damned if you do, damned if you don’t,” says Holland, 56. “If I didn’t have Obamacare, I wouldn’t have the quality of insurance I have now.”

The federal government forms for applying for health coverage under Obamacare. (Jonathan Bachman/Reuters)

How long Holland will continue to have Obamacare is anyone’s guess. Since taking office, President Trump has wasted little time keeping a campaign promise to repeal and replace the ACA. His first executive order was to instruct all federal agencies to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden” on individuals, businesses and others affected by the law.

Experts debate the impact the order will have on Obamacare, but it could, in the short term, waive the penalties that individuals and employers face in dealing with the ACA’s mandates. That alone would be a step in the right direction for groups such as the National Restaurant Association, which has opposed the employer mandate — and all the administrative burdens it places on businesses.

On the other hand, if the Republican-led Congress dismantles the ACA, millions of workers might find themselves without health insurance, or with a policy with fewer benefits, depending on what the GOP offers as a replacement. Four Senate Republicans put forth a new health-care plan on Monday that would allow states to tailor their insurance systems but would maintain the ban on denying coverage based on preexisting conditions. Other proposals are forthcoming.

Restaurant workers could be among the hardest hit by a rollback. With more than 14 million workers nationwide, the hospitality industry employs 10 percent of the American workforce, according to the National Restaurant Association. And many of them are on edge as Congress reconsiders Obamacare, says Saru Jayaraman, co-founder and co-director of Restaurant Opportunities Centers United (ROC-United), an advocacy group for restaurant employees.

President Trump hands Chief of Staff Reince Priebus, right, an executive order that directs agencies to ease the burden of Obamacare. (Jonathan Ernst/Reuters)

By ROC-United’s estimates, about 10 million restaurant workers are now covered under the ACA or Medicaid, which was expanded in many states under Obamacare.

“Very few restaurant workers before the ACA had anything at all,” she says. “When you have [insurance], then you start to deal and treat things that have been a problem for a very long time. When you cut it off, it’s almost worse” than never having insurance at all.

ROC-United has, for years, floated a theory: What’s bad for American restaurant workers is bad for the American people. The hospitality industry, the organization argues in a 2010 publication, “Serving While Sick,” offers low-paying jobs in a fast-paced, high-risk environment with hot stoves, sharp knives and slick floors. In surveys of more than 4,300 restaurant workers, nearly half of them reported they had been cut on the job. More than 63 percent reported they had cooked or served food while sick.

Employees, of course, rely on workers’ compensation for accidents that occur in the restaurant, but before the ACA, many had no insurance to pay for hospital visits for injuries at home or elsewhere, Jayaraman says. U.S. taxpayers end up footing the bill for those unpaid hospital bills, she says, just as American diners pay the price for cooks and servers who, without access to health care or paid sick days, show up for work when ill. The Centers for Disease Control and Prevention notes that “most norovirus outbreaks from contaminated food occur in food service settings like restaurants,” the result of sick employees.

“We all know that our folks work sick,” says Jayaraman. “They perpetuate the public health problem.”

Sarah Gordon is the co-owner of Gordy’s Pickle Jar, the Washington-based company dedicated to pickled produce, and she is no longer sick. This month, Gordon will celebrate her 14th year of being cancer-free. She’s just 35 years old.

In 2003, when she was a senior in college, Gordon was diagnosed with soft-tissue sarcoma in her right buttock. She was devastated. Always active, she was told she might never run again. But after nine months of treatment, Gordon survived the cancer scare with a minimum of damage. “The only thing I can’t do is tie my shoe” because of scar tissue, she says.

The bills for her care were large, Gordon remembers. She doesn’t recall the final price. She, after all, was on her parents’ insurance at the time. But she frets now about her own coverage, which she purchased through the ACA. It’s a plan, for which she pays about $214 a month, without any subsidy. Her deductible is high — $5,000 — and her maximum out-of-pocket expense per year is $7,150. But the plan appears to cover everything she would need should her cancer return.

The thought that she might be denied coverage in the future because of her preexisting condition sets Gordon’s teeth on edge. (Gordy’s, incidentally, will start offering health insurance this year to its four full-time employees.) She equates it to the days before same-sex marriage was legal in the United States: An insurance company can deny you benefits based on who you are. “It makes me feel like I’m being discriminated [against] for having a preexisting disease,” she says.

Demonstrators support the Affordable Care Act at a rally in Newark on Jan. 15. (Stephanie Keith/Reuters)

The National Restaurant Association’s board of directors is meeting this week to determine its official stance on the repeal and replacement of Obamacare. Historically, says association spokeswoman Leslie Shedd, the group has not supported a full repeal, but has lobbied the government to ditch the employer mandate, which comes with huge amounts of paperwork for businesses with more than 50 employees. A repeal of the mandate, the group argues, would not be the death of employer-provided health insurance.

“Our employers see offering health insurance as a very powerful tool to recruit and retain employees,” says Robin Goracke, the association’s director of health-care policy.

But ditching the mandate would relieve larger restaurants of the administrative burdens. The paperwork includes monthly reports listing the number of full-time employees, the health coverage offered to them (and their dependents), if any, and how much employees paid out of pocket for monthly premiums. This kind of tracking would be burdensome for any company, the association argues, but it’s even tougher on restaurants with typically high turnover.

Goracke estimates the ACA’s reporting requirements can cost a restaurant between $30,000 and $400,000 a year in labor or outside vendor fees. This is money, she notes, “that’s not actually improving the health care they offer employees or improving their restaurants.”

About the possibility of changes to Obamacare, Tom Holland says, “I’m trying not to think about it.” (Astrid Riecken/for The Washington Post)

Tom Holland will soon be shelling out money, too. His biopsy results came back on Jan. 13. It was a Friday, naturally. The exam confirmed his fears: He was diagnosed with squamous cell carcinoma, a skin cancer that, left untreated, can lead to “serious complications,” according to the Mayo Clinic.

He had no time to contemplate the dark Shakespearean turn his life had taken: For more than 20 years, he was the proprietor of a cafe dedicated to helping people eat healthful meals, but had to shut down his business in October to focus on his own health. The cafe had been struggling with declining revenues, which is why he had stopped offering health insurance for his 12 or so employees a few years ago — and part of the reason he hadn’t been following up with his own medical treatment.

Right now, Holland had to start seeing oncologists to understand how far the cancer had spread during the months he did nothing to stop it. This week, he underwent a PET-CT scan, which offered some good news: The cancer remains localized in his neck. He plans to have a biopsy Friday to determine whether he needs to remove his tonsils, and possibly more tissue, as well as the cancerous growth. Surgery is planned for next week.

Holland’s HMO plan under Obamacare includes a $1,000 deductible and a maximum out-of-pocket expense of $4,500. So far, he’s paid only $30 co-pays for office visits. The bills will come due later. But for now, at least, his cancer treatments are covered.

That could change when Obamacare changes. In the eyes of a new provider, Holland will officially have a preexisting condition called cancer.

“I’m trying not to think about it,” Holland says. “At this point, what am I going to do?”